Self-medication among Medical Students and Staffs of a Tertiary Care Centre during COVID-19 Pandemic: A Descriptive Cross-sectional Study

ABSTRACT Introduction: Self-medication is a common practice worldwide. Major problems related to selfmedication are wastage of resources, increased resistance of pathogens, adverse reactions, and prolonged suffering. This study aimed to find the prevalence of self-medication among medical students and staffs of a tertiary care centre during the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted among medical students and staffs of a tertiary care centre from 1st November to 30th November, 2021. Ethical clearance was taken from the Institutional Review Committee (Reference number: 2710202102). Convenience sampling was done to reach the sample size. Online questionnaires consisting of information on self-medication and socio-demographic characteristics were used. The data was transferred into an Excel spreadsheet and later was exported to Statistical Package for the Social Sciences version 20 for analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Among 383 participants, the prevalence of self-medication during the pandemic was 193 (50.4%) (45.39-55.40 at 95% Confidence Interval). About half of the respondents 90 (50.3%) who selfmedicated purchased the medicines directly from the pharmacy. The most consumed medicines were Paracetamol 128 (18.9%), Vitamin C 126 (18.6%), Zinc 86 (12.7%), Multivitamins 75 (11.1%), and Vitamin D 65 (9.6%) followed by Azithromycin 54 (8%), cough syrup 53 (7.8%) and Ibuprofen 46 (6.8%). Conclusions: The prevalence of self-medication during the COVID-19 pandemic is lower compared to that of other developing countries. Paracetamol and Vitamin C are the most consumed drugs for self-medication and Azithromycin is the most used prescription-only drug for self-medication during the COVID-19 pandemic.


INTRODUCTION
The World Health Organization defines self-medication as the selection and utilization of medicines to treat selfrecognized symptoms or ailments without consulting a physician. 1 Family, friends, neighbours, the pharmacist, previous prescribed drug, or suggestions from an advertisement in newspapers or popular magazines are common sources of self-medication.² Self-medication is a common practice worldwide. 3 During the pandemic, the constant fear of going outside and using health services may have an impact on the use of self-medication. 4 At this stage of the pandemic, self-medication is found as a common practice in many countries. 5 Major problems related to self-medication are wastage of resources, increased resistance of pathogens, and serious health hazards such as adverse reaction and prolonged suffering. Antimicrobial resistance is a current problem worldwide particularly in developing countries where antibiotics are available without any prescription. 6 This study aimed to find the prevalence of selfmedication among medical students and staffs of a tertiary care centre of Nepal during the COVID-19 pandemic. p= prevalence of self-medication among medical students and staffs of a tertiary care centre taken as 50% for maximum sample size q= 1-p e= margin of error, 6%

METHODS
The minimum sample size calculated was 267. Taking 10% non-response rate, the sample size becomes 294. However, the total sample size taken was 383.
The main instrument to collect data was an online questionnaire. An online questionnaire was prepared using Google forms and was sent to participants through email, social media (Facebook, Instagram, Viber, and Whatsapp). The survey was kept brief to achieve greater response rates. Pretest was conducted among 20 participants for clarity and content prior to dissemination for others. Day-to-day supervision of sent questionnaires was done. Those who did not respond were sent up to three reminders.
The data was transferred into an Excel spreadsheet and later exported to Statistical Package for the Social Sciences version 20 for data analysis. Descriptive statistics were used, and variables were represented in terms of percentages. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

DISCUSSION
The magnitude of self-medication during the COVID-19 pandemic in our study was 193 (50.4%). Three studies in Pakistan, Bangladesh, and Togo have reported the prevalence of self-medication during the COVID-19 pandemic to be 53%, 71.40 %, and 34.2% respectively. [7][8][9] The prevalence of self-medication in Pakistan was similar to this study whereas it was much higher in Bangladesh and lower in Togo.
In this study, 17.2% of respondents medicated without any symptoms for prevention. This was consistent with the study in Bangladesh. 8 The majority in our study, who selfmedicated, obtained the medicines directly from a pharmacy. The study in Pakistan mentioned, for the majority, the source of the drug was either a prescription written for a family member or directly from the pharmacy. 7 Directly from the pharmacy may be a common source of self-medication in countries like Nepal and Pakistan because dispensing of medicines from pharmacies is not strictly regulated in these regions. and Vitamin C and as the most consumed medicine for self-medication respectively. 5,9 The most used 'prescription-only' drug for selfmedication was Azithromycin. Though the use of Azithromycin has increased during the COVID-19 pandemic, routine use of azithromycin for COVID-19 in absence of additional indication is not recommended. 10,11 Instead, inappropriate use of antibiotics can further lead to increased antimicrobial resistance. Adverse effects were seen using medicines which were also seen in other studies. 7,12 The limitation of this study was that the limited sample size and the convenience sampling technique could not make the results representative of the entire population.

CONCLUSIONS
This study concludes that the prevalence of selfmedication during the COVID-19 pandemic was lower compared to that of other developing countries.
Paracetamol and Vitamin C were the most consumed drugs for self-medication and Azithromycin was the most used prescription-only drug for self-medication during the COVID-19 pandemic.